Harms associated with invasive procedures used to manage chronic pain
Harms associated with invasive procedures used to manage chronic pain include:
- pain at the procedure site
- compression or haematoma from bleeding at the procedure site (eg spinal cord compression, epidural haematoma)—coagulopathy is a contraindication to invasive procedures when the harm associated with bleeding outweighs the expected benefit of the procedure
- complications from inadvertent needling of neural or deep structures (eg leak of cerebrospinal fluid)
- inadvertent spread of the drug to adjacent structures
- embolisation of drug particles (eg particulate corticosteroid formulations)
- systemic toxicity, especially if large doses are used or intravascular injection occurs
- allergic reaction to the drug
- infection—contamination of the procedure site, which may result in infection; do not perform an invasive procedure in patients with a preprocedural systemic infection or infection at the procedure site
- procedure-related anxiety, distress or vasovagal syncope
- financial expense, especially with neuromodulation (spinal cord stimulation).
Additional harms associated with neuromodulation (spinal cord stimulation) include system malfunction, and migration or fracture of the electrode lead.
In patients receiving opioids, anticipate the need for opioid tapering because removing the painful stimulus with an invasive procedure can lead to unopposed opioid effects, causing opioid toxicity.
Harms associated with an invasive procedure may outweigh the benefit in the following patients:
- pregnant women
- frail elderly
- immunosuppressed people
- those unable to cooperate
- those with significant respiratory or cardiovascular compromise
- those with altered anatomy that affects the safety of the procedure.
In some cases (eg palliative care patients), the potential benefit may outweigh the harm when treating severe refractory pain.